Provider Demographics
NPI:1154908325
Name:KHAZAK, ANDRE (DO)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:KHAZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ST LUKES BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5671
Mailing Address - Country:US
Mailing Address - Phone:484-503-4673
Mailing Address - Fax:
Practice Address - Street 1:1600 ST LUKES BLVD FL 2
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5671
Practice Address - Country:US
Practice Address - Phone:484-503-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330170208M00000X
PAOT024318207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist